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HIV Among Black Women

Social Factors Make Group Vulnerable

Barbara Chinn
Director, Max Robinson Center at Whitman-Walker Clinic
Monday, February 7, 2005; 3:00 PM

Barbara Chinn, director of the Max Robinson Center at the Whitman-Walker Clinic in Washington, D.C., will be online Monday, Feb. 7, at 3 p.m. ET to discuss the growing HIV rate among black women.

Read the story:U.S. HIV Cases Soaring Among Black Women (Post, Feb. 7)


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A transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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Barbara Chinn: Good afternoon. I'm glad that you are showing an interest in this pandemic of HIV and AIDS.

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washingtonpost.com: Barbara Chinn, welcome to washingtonpost.com. The story in today's Washington Post states that the reasons for HIV rates rising for black women is because of socioeconomic and demographic conditions specific to many African Americans. Do you agree with that? If so, can you please explain?

Barbara Chinn: Yes, I do agree with it as one of the main causes. Women, especially in Washington, D.C., find that they are in competition for men. They're also in a position where they are not financially secure so therefore they rely on the male to address much of their economic necessities. The culture of African Americans is one where the woman is subservient in her ability to question the man. Women do not possess the ability to negotiate for risk reduction behaviors.

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Rockville, Md.: Ms. Chinn,
The issue of skewed ratios of men to women in some urban neighborhoods has been studied by sociologists, among others. One of the identified problems has been the widespread lack of jobs for less educated men (now that industrial jobs are largely gone in places like Chicago and Detroit). Could WOMEN's HIV/AIDS infection risk be reduced by seeing to more services (including employment and adult education) for MEN?
Thank you for your answer.

Barbara Chinn: I think the main problem that we're facing is men who have sex with men who do not identify as gay and injection drug users. The socioeconomic piece also plays into it but the main issues are around the injection drug use and the same-sex partners.

If you're going to give women the ability to become empowered, then the answer is yes, that employment and adult education would help the problem. It would give them the ability to feel that they have a choice and not be dependent on someone else.

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New Orleans, La.: Where can I go online to research HIV cases and percentages from state to state and race/ethnicity?

Barbara Chinn: Centers for Disease Control and Prevention.

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Washington, D.C.: When a couple is in a monogamous relationship and tests negative for HIV and is then re-tested six months to a year later and the results are still negative, is it safe to assume that the individual(s)are not infected? If not, then how long should it be before one can consider him/herself "in the clear"?

Barbara Chinn: The answer on the surface, yes, it is reasonable to assume that you're not infected. The window period can be anywhere from a few weeks to six months. But one of the things you want to not assume is that what was a monogamous relationship is continuing to be a monogamous relationship. That's not to imply that everyone is going to go out and have extramarital affairs but if people's habits change, their patterns change, then you need to be more cautious.

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Bethesda, Md.: Ms. Chinn,
I am a SBF and I find these numbers startling. Is it fair to blame all the hype over the "down low" men in jail, etc., or is it simply that as black women we are more careless when it comes to protecting ourselves? We buy into the limited supply of black men and are willing to do anything to keep a man at any cost?

Barbara Chinn: It's all interrelated. In keeping a man at any cost is part of it. The men in jail, the men who have sex with men, the injection drug users, the general promiscuity, a lack of ability to say "no condom, no sex." We have to learn how to take charge of our lives.

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Washington, D.C.: Dear Ms. Chinn,
It is good to see this important topic generate some interest in the press. Are junior high or high school the best places to target safe-sex messages to young women at highest risk (those in disadvantaged socioeconomic situations)? How does one deal with the challenge to sex education programs posed by those who would teach abstinence-only programs?
Thank you.

Barbara Chinn: I believe you have to start talking to children before they get to junior high school about sexual activity. You talk to children in an age-appropriate manner, whether it's about HIV or just plain not indulging in sexual activities. I would like to see the schools do something that is more proactive along HIV education. Schools might even consider dual tracks on the issue, meaning to teach the abstinence-only methodology or for those that they know who are sexually active, to give them the information they need.

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Washington, D.C.: As a black woman, this issue is of great concern to me. I'm engaged and me and my fiance have both been tested multiple times. But with the whole "down low brother" phenomenon and extra-marital affairs, even those of us who think we're in committed relationships are not immune from the virus. What are we supposed to do? How can I be in a committed, trusting relationship with my partner and protect myself from HIV? I don't want to force him to use condoms; abstinence is not an option. I've talked to him extensively about being honest and open if he feels the need to explore sex with others. But he knows doing so would be the end of our relationship, so I can't trust that he would let me know. So please tell me what am I supposed to do? This issue is ravaging the African-American community because it is breeding distrust among black men and women. We have enough problems, we don't need this one too.

Barbara Chinn: You're wise to be concerned. I agree that the trust issue has to be examined very carefully but first and foremost it is you who must protect yourself.

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Washington, D.C.: Are we suggesting that African-American men are the only source/cause of African-American women contacting the HIV virus and the numbers to increase?

Barbara Chinn: You can contract HIV through a few modes of exposure but majorally it is contracted by having sex with men who have had sex with other men regardless of their color. Or by having sex with someone who is infected as a result of their injection drug use or your sharing contaminated needles or your coming in contact with blood or semen. And what would not be of concern to an adult would be breastfeeding or the fetus would not infect the mother. The transmission is from mother to child, not child to mother.

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Dallas, Tex.: I have recently heard health officials make the suggestion that married couples practice safer sex (i.e., condoms) and only remove a condom if trying to conceive (if HIV tests are negative). This is even if premarital HIV testing is negative. Do you agree with this idea; it seems a bit unrealistic.

Barbara Chinn: Each couple has to make their own choice and it should be based on how much they trust each other. I would assume in most relationships that trust is earned and if trust is broken, one would act accordingly.

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Washington, D.C.: What are the ongoing efforts to wake up the black community in the District? Specifically through black churches and the city government. What do you think it is going to take for the greater African American Community to take this epidemic seriously?

Barbara Chinn: We have to wage war on this epidemic from all fronts. There is no one place where you will find the answer. Churches, schools, homes, parents, grandparents, friends, aunts, uncles ... it's going to take everybody getting involved. First, teaching our young that abstinence is the 100 percent foolproof way to protect oneself, but if you are going to engage in sexual activity, there is a way to address it without putting yourself in a high risk category.

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Cincinnati, Ohio: Keith Boykin reveals in his new book, "Beyond the Down Low, Sex, Lies and Denial in Black America" that there is no evidence to support the notion that most of the cases of HIV infections in black women are caused by men on the "down low." This contradicts the common "wisdom" now raging in the black community, in large part, the result of JL King's sensationalistic book about the down low. Boykin reveals that the overwhelming majority of HIV infections in black woman are caused by IV drug use, not down low men. This misconception slanders all black men and especially gay and bisexual men.

Barbara Chinn: All I would do is suggest that you look at the CDC statistics in terms of modes of exposure and it seems to bear out the majority of the cases reported seem to fall into the category of men who have sex with men. Whether you want to call them on the "down low" or another euphemism, it's about what you do.

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Herndon, Va.: Have there been any studies to see if there is any difference in condom usage among varying groups insofar as "race" and gender is concerned? African American, "whites," Latin Americans, heterosexual/homosexual, etc

Barbara Chinn: I have heard of such studies being done. Do I have direct information from them? No. But there are some cultural barriers to condom use that have to be taken into consideration. One of them is the belief that condom use keeps the African American community from growing. Another has to do with "you take away my manhood if you insist I use a condom," another is not just specific to African Americans, but "sex is for procreation" and you will find that linked with Catholicism so it is also something thought of not only in the African American community but also in the Latino community. So there are number of reasons why people object to condom use.

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San Antonio, Tex.: What a tragic story that HIV/AIDS is on the increase among African Americans. I can't help but think of yesterday's Super Bowl commercial where African Americans men talk about sharing a girlfriend, as if she were a simple commodity. This ad is shameful. Do you think that part of the problem that can help to explain the HIV/AIDS increase in numbers is our permissive culture, let alone the mass media that fuels it?

Barbara Chinn: It raised my eyebrows when I looked at it also.

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Alexandria, Va.: Ms. Chinn --

I am particularly intrigued by the "down low syndrome".

My best friend who is black and gay always argues when people ask him why he CHOSE to be gay. His response is, "It's hard enough being a black male in White America. Why I choose to be a Gay black male in straight white america?"

I also have a friend who teaches at Howard that says black gay students have no support. And black churches are more willing to take someone who killed somebody but no gays, God forbid.

What can we do to make things easier on bisexual black men? I don't condone their behavior. After all, as you can see, keeping a secret can kill you. But if the community was more open ...

I have several white friends who know their partner is bisexual and they just deal, taking necessary precautions.

What are your thoughts?

Barbara Chinn: Until the churches become more accepting that we are all God's children, that God created us in his image, whatever that is, we will have this finger pointing and stigmatization that will be a barrier to our finding a solution to this disease.

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Washington, D.C.: Would you happen to have statistics on how many black men and women have AIDS or HIV in the District?

Barbara Chinn: As if Dec. 31, 2002, there were 8,200 men and women in D.C. alive with AIDS. We estimate one in 20 are infected and the reason we don't have an exact count is because HIV positive status is not reportable, not mandatory, whereas a full-blown AIDS diagnosis is reportable.

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Washington, D.C.: Do you think the nature of HIV/AIDS (takes a very long time to show itself) lends itself to risky choices? A female in the article knew her man to have AIDS but still willingly had sex with him w/o protection. Do you think if the disease was more instantaneously fatal and painful (like Ebola) that would scare people into making better choices?

Thx

Barbara Chinn: Not necessarily, but one of the things I hear is "they don't look sick" and that's not the answer. Information is the answer. Getting tested and knowing your status is the answer. Making sure you practice risk reduction behaviors is the answer.

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Alexandria, Va.: Does this study take into consideration of those African American woman that may have contacted the HIV virus from men other than those that are African American if, as the story hints, that there is a lack of avariciousness men?

Barbara Chinn: The answer is yes, it's possible, but the majority of the African American women are engaging in sexual activity with African American men. But the bottom line is that HIV does not discriminate. No one is exempt. You can contract it from anybody if you do the wrong things.

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Washington, D.C.: Do you feel that the African American community has embraced a mindset of hopelessness and despair allowing for the spread of HIV/AIDS? If so, what do you suggest can be done to change such a destructive way of thinking?

Barbara Chinn: I think part of that plays into why we are reluctant to get tested. "If I cannot pay my rent, if I cannot put adequate food on the table, buy shoes for my kids, why do I need to know if I'm HIV positive when there's nothing I can do about it? It's just another problem in the myriad of things of which I have no control. So I really don't need to know, there's nothing I can do about it."

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High School: I am a teacher in an impoverished area in North Carolina. What resources are available for black female teenagers to help them understand what a serious threat this disease is to their health, specifically? Are there any outreach efforts that target High School students?

thank you

Barbara Chinn: I would suggest you investigate. If you are unable to identify any type of an outreach program, then try to find a way to help educate those young girls.

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Washington, D.C.: Thank you for hosting this session. What do you see as the main barrier(s) to implementing effective outreach and prevention programs in Washington, D.C., to control spread? Is it funding? Lack of adequate work force to work with the affected hard-to-reach populations? Lack of leadership from our elected officials, medical professionals, etc? And what steps would you recommend that federal, state, and local public health agencies take to help stem rising incidence of HIV in African Americans (male and female)?

Barbara Chinn: All of the above. Not to imply that there is no leadership or there are no funds, it's just that we need much more. The president in his State of the Union address said he was pushing for the reauthorization of the Ryan White Care Act which goes to fund HIV/AIDS programs, both prevention and medical care. But we need more than flat funding. We need a significant increase if we are going to take HIV as seriously as we take Iran, Iraq. Then we need to put some serious dollars behind this.

Again, I go back to the funding component for the second part of your question. I go back to the money. You need money for outreach workers; you need the money for medical care, for treatment. We need private entities to get involved, meaning, as they say, "it takes a village to raise a child," it's going to take a nation to get rid us of this disease.

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Barbara Chinn: I am very much encouraged by the number of questions that came in today. It means that people are paying attention. Don't let it die today. This is just one day. We need this 365 days a year so that it is on the forefront of everyone's mind. We cannot let it slip.

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